School-Based Caries Prevention Programs and Recruitment of High-Risk Pediatric Medicaid Populations.

Importance: Pediatric dental-related emergency department visits have drastically increased in recent years. School-based caries prevention programs (SCPPs) aim to address unmet dental needs, yet it is unclear whether they effectively reach high-risk populations. Objective: To determine whether children with prior dental care utilization are more likely than children without prior utilization to participate in SCPPs. Design, Setting, and Participants: This cross-sectional study, conducted between June 2023 and October 2025, linked 2019 SCPP clinical trial data and 2016 to 2019 Medicaid claims data to examine disparities in sociodemographic characteristics and dental and dental-related medical care utilization prior to SCPP implementation between participants and nonparticipants. SCPPs were implemented in 47 primary schools in New York, New York, primarily in the Bronx, which was deemed to have the highest risk of tooth decay in the city. Participants included children aged 5 to 13 years in 2019 residing in the Bronx and continuously enrolled in Medicaid between 2018 and 2019. Exposures: Dental and dental-related medical care utilization in 2018, the year prior to SCPP implementation, demographic factors, individual-level clinical dental needs, and health system factors. Main Outcomes and Measures: The primary outcome was SCPP participation in 2019. Adjusted logistic regression was used to assess whether prior dental care use was independently associated with participation. Results: The study included 63 217 children in total (62 187 nonparticipants and 1030 participants), with a mean age of 7.7 years (95% CI, 7.6-7.7 years). There were 30 590 female children (48.4%), 1852 Asian children (2.9%), 13 926 Black children (22.0%), 31 620 Hispanic children (50.0%), and 1988 White children (3.2%). In multivariable analysis, compared with any dental visits, having no dental visits prior to SCPP implementation was associated with 17% lower odds of participating (adjusted odds ratio, 0.83; 95% CI, 0.71-0.96). Compared with having any dental emergencies, having no dental emergencies was associated with 32% increased odds of participating (adjusted odds ratio, 1.32; 95% CI, 1.08-1.62). Mitigating selection from a statewide SCPP rollout was estimated to save up to $2.4 million in nontraumatic dental-related emergency department visits. Conclusions and Relevance: In this cross-sectional study of NY Medicaid claims data linked to SCPP participation data, there was evidence that children at high risk of tooth decay who are most in need of dental preventive services have a lower likelihood of participating in school-based prevention programs. More evidence is needed to identify successful strategies for recruitment of high-need children.